SPECIAL FEATURE: How Christians overcame the culture of death

by Peter Hung Manh Tran

News Weekly, August 19, 2006

Disabled and chronically sick citizens were viewed by the ancient Greeks and Romans as burdens on society. Euthanasia, physician-assisted suicide, abortion and the killing of deformed and sickly infants were widely practised by the ancients in pagan times.

According to Dr Peter Tran in his new book (details below), it was the emergence of Christianity that saw these practices eventually condemned and made illegal. Christians believed that, because humans were created by God in His image, all human life was sacred. As a result, they resisted the notion that any human being should be considered unwanted or unworthy of life and nurturing.

This is an edited extract from Dr Tran's book.

Euthanasia and assisted suicide have become the dominant social, political and moral issues in recent years. While various forms of euthanasia have been practised for thousands of years, it did not become a major issue of public debate until the 20th century. Thus the debate over euthanasia and assisted suicide is not new, as Ezekiel J. Emanuel has documented in an article in Annals of Internal Medicine 121 (1994); only the emphasis has shifted. In a thoughtful and thorough survey of the euthanasia movement, The Right to Die: Understanding Euthanasia (New York: Harper & Row, 1986) Derek Humphry and Ann Wickett trace the issue from classical Athens, where magistrates kept a supply of poison for anyone who wished to die, through to the rise of Christianity which denounced suicide as a violation of God's will.

By the fifth century BC, Greek physicians and the aristocracy were heralding health as a human value par excellence. Accompanying this ideal, Greeks ascribed superior status to the healthy and regarded sick persons as weak and inferior. To promote health and preserve life is the heart of the physician's art, the ultimate goals of which were "to bring health in all cases of sickness [and] preservation of health to those who are well".

However, Greek physicians were urged to recognise the limitations of their art, since their goals were "to do away with the sufferings of the sick, to lessen the violence of their diseases, and to refuse to treat those who are overmastered by their diseases". Therefore, Graeco-Roman views of euthanasia harmonised with these understandings of health, healing and human excellence.

Philosophers such as Plato and Aristotle, saw the value of human life as primarily social - that is, in terms of its potential contribution to society. There was no concept of the inherent sanctity of human life; therefore the belief was that chronically sick persons were expendable.

Unable to carry out active, socially useful lives, these persons consumed the vital resources of family and community. With or without their requests and consent, their lives could be ended justifiably.

Seneca and earlier Stoics praised the capacity of humans to choose how to end their lives. Humans ought to quit life nobly, rather than passively await the cruel endings "either of disease or of man". Preferring voluntary death to extended agony, sufferers of dreadful injuries and diseases were readily given life-extinguishing poisons - in particular hemlock - by willing physicians. This philosophy had been revealed in Seneca's eloquent words:

"Against all the injuries of life I have the refuge of death. If I can choose between a death of torture and one that is simple and easy, why should I not select the latter? As I choose the ship in which I sail and the house which I shall inhabit, so I will choose the death by which I leave life. In no matter more than in death should we act according to our desire. ... Why should I endure the agonies of disease ... when I can emancipate myself from all my torments?"

Extinguishing unwanted lives

These strands of opinion and practice display how Graeco-Roman thought and practice endorsed the permissibility of euthanasia both in the form of voluntary death for sufferers and in the form of extinguishing the lives of unwanted humans involuntarily. This view included putting to death deformed and sickly infants.

In contrast to the dominant Greek traditions sketched above, Pythagoreans and the early Christians opposed physician-assisted euthanasia in an almost Hebraic sense. The Judeo-Christian concepts of transcendent monotheism and "image of God" led to a new definition of the value of life.

Because humans were seen as having been created by God in His image, all human life is sacred; taking life is an usurpation of divine power and an insult against God. Since Christians regarded God as the sovereign creator and sustainer of human life, His commandments were to be obeyed.

From its beginnings, Christianity opposed self-induced death out of suffering or despair. Contrary to the myth that many people committed suicide to escape from life and be with God, or to avoid sin, early Christians ardently opposed self-induced death. These themes informed early Christian critiques of Graeco-Roman society (1 John 2:15–4:21).

Gladiatorial spectacles

By the second and third centuries, Christianity's defenders were condemning gladiatorial spectacles, abortions, infanticide and self-induced death. No human group was considered unwanted or unworthy of life and nurturing.

In the fourth century, St Augustine's elaborate criticism of suicide, including ending one's life because of raging pain, appealed to the Bible as authoritative and addressed justifications of self-induced death by Stoics and others.

Like Aristotle, Augustine regarded self-inflicted death as cowardly. He viewed it as contrary to the fifth commandment, "Thou shall not kill". He also regarded self-killing as a serious sin because it excluded the possibility of repentance.

With the establishment of Christianity as the officially-sanctioned religion of the Roman Empire after 325, self-killing became equated with homicide. Within central and northern Europe, the property of suicides was confiscated, their corpses were desecrated, and they were excluded from Christian burial grounds.

By the 12th century and thereafter, St Thomas Aquinas (1225-1274) and other Catholic theologians followed this reasoning. Aquinas also expanded upon past arguments against suicide in ways that deeply inform Roman Catholic perspectives to the present time. Suicide, and, by extension, euthanasia for sufferers, were and are viewed as contrary to Christian tradition, to natural law, to the well-being of civil society, to Christian compassion, and, most important, to the dominion of God over human life.

While both Augustine and Aquinas made strong statements against suicide and infanticide, both forms of euthanasia were not uncommon in the Middle Ages. Probably due to economic and social problems caused by war and the plague, the incidence of euthanasia increased during this period.

Moreover, as medicine became an organised profession, euthanasia was no longer just an issue between individuals and their church, but began to involve physicians as well. Yet both Protestant and Catholic Churches continued to condemn euthanasia, as did the law of the land.

However, while forbidding the intentional killing (euthanasia) of all innocent human beings, contemporary Roman Catholicism permits letting incurably and terminally ill persons die by forgoing life-sustaining measures. While ordinary means of prolonging life are required, technical measures that impose strain or suffering disproportionate to foreseen benefits may be discontinued. This prescription includes refusing "forms of treatment that would only secure a precarious and burdensome prolongation of life" in the face of inevitable death:

"One cannot impose on anyone the obligation to have recourse to a technique which is already in use but which carries a risk or is burdensome. Such a refusal is not the equivalent of suicide [or euthanasia]; on the contrary, it should be considered as an acceptance of the human condition, or a wish to avoid the application of a medical procedure disproportionate to the results that can be expected."

As minority points of view within the dominant framework of Judeo-Christian culture, various secular thinkers from the 16th through to the 19th centuries spoke of the permissibility of assisting death for seriously sick and injured persons.

David Hume (1711-1776) in his essay "On Suicide" proposed to examine "all the common arguments against suicide" and show that it can be free "from every imputation of guilt or blame". Expressing views similar to those of Socrates and Plato, Hume predicated the morality of self-killing on one's duties to society. He reasoned that persons plagued with suffering to the point of negating their social usefulness were under no moral obligation to prolong their lives.

Hume also criticised Thomas Aquinas's main arguments against suicide and voluntary active euthanasia. He held that sickness, overwhelming suffering, and accompanying wishes to die should be regarded as calling persons from life "in the clearest and most express terms".

Throughout the 18th and 19th centuries, Hume's arguments were often opposed as the harmful opinions of a Scottish infidel. Hume's critics included Immanuel Kant (1724-1824), who viewed self-killing as immoral because it could not be willed as a universal course of action without undermining the very possibility of morality, namely the existence of rational beings. Kant also viewed voluntary euthanasia as a violation of one's duty to God, the sovereign of all life.

Survival of the fittest

In the 19th century, new theoretical support for euthanasia emerged. Social philosophies emphasising the individual's freedom to act in his self-interest to control the environment (such as those of Karl Marx and Frederick Nietzsche) and scientific theories of evolution and survival of the fittest (such as those advocated by Charles Darwin and Herbert Spencer) lent support for the practice of euthanasia on individuals with a low quality of life and/or a lack of social value.

But not until the end of the 19th century did arguments similar to Hume's enter the realm of public debate and advocacy respecting voluntary euthanasia. Like Hume, Arthur Schopenhauer (1788-1860), Friedrich Nietzsche (1844-1900), and others who advocated induced death appealed to the right of autonomous persons to end their lives when terminal disease extinguished pleasure and social usefulness.

Debates over the permissibility of physician-induced death for incurable sufferers first developed in Great Britain and the United States in the last decades of the 19th century. Although the declining influence of religion in the face of secular onslaughts made the debate possible, discussion centred on doctors because they could diagnose incurability with far greater accuracy and, armed with chloroform and hypodermic morphine, they could end pain - and life - with ease.

By the middle of 20th century, however, physician control was directed toward sustaining life by technical means. Noting how medical practice had "deteriorated" with respect to "the art of caring for the dying", Alfred Worcester gave a warning to his peers for their overuse of "modern methods of resuscitation". In "defiance of nature" and against the "merciful release" of death, "too many of our profession", Worcester warned, feel "duty bound to do their utmost. They ought to know better."

Such warnings often went unheeded as attempts to prolong life grew increasingly heroic and technologically complex. In the early 1900s, artificial circulation by cardiac massage and injections of epinephrine to the heart were introduced. Various types of mechanical respirators were employed in the 1930s, and in response to the polio epidemic of the early 1950s, the use of iron lung respirators became common.

As noted, the permissibility of letting terminally ill persons die by forgoing life-sustaining measures accorded with Jewish, Catholic and Protestant traditions. For example, the Washington and Oregon bishops stated: "In appropriate circumstances, the decision to withhold these means of life-support can be in accord with Catholic moral reasoning and ought to be respected by medical caregivers and the laws of the land."

This view also harmonised with the dominant principle of post-1970 secular medical ethics: respect for the autonomous choices of patients and the principles of individual freedom and privacy inherent in Anglo-American law.

For example, virtually all states in the United States have formally recognised the right of patients to forgo treatment, including artificial nutrition and hydration essential to life, and have given legal sanctions to advanced directives such as "living wills" and durable powers of attorney that permit patients to designate a guardian to decide whether life-sustaining treatment should continue. The legal basis for refusing treatment derives from a long recognised common-law right to be free from bodily interference without consent.

Around the beginning of the 20th century, the notion of self-interested control of the environment combined with evolutionary theory to give birth to the idea of using state power to eliminate the unfit and create a perfect nation.

By the 1920s, the concept of "Lebensunwerten" (life not worth living) had been popularised throughout Europe and gained the official approval of the German Government. It would later provide the rationale for the Nazi atrocities, both against the mentally and physically infirm and what would be defined as the "inferior races".

Prior to the extermination of the millions of Jews and other so-called "undesirable" peoples such as the homosexuals and Gypsies, the policy led to the elimination of about 100,000 Aryan German men, women and children who were mentally ill and/or physically handicapped. All were killed in the name of euthanasia.

The Nazi murders significantly affected how people viewed euthanasia for a generation. As Derek Humphry put it, it "effectively hampered the intellectual and legal progress of the euthanasia movement" in the English-speaking world.

Although many non-Western societies accept infanticide and adult mercy-killings, in at least some circumstances, the only Western industrialised nation where euthanasia is widely practised and socially acceptable is the Netherlands.

- Dr Peter Hung Manh Tran was born in South Vietnam and migrated to Australia as a refugee in 1982. An ordained priest and a doctor of moral theology, he has lectured and written books on bioethics.

His new book, from which the above extract comes, is available from News Weekly Books: